Caesarean Scar Ectopic Pregnancies: A Novel Medical Management Approach in Bangladesh

Background: Caesarean scar ectopic pregnancy (CSEP) is a rare but potentially life-threatening condition where implantation occurs within the scar tissue of a previous caesarean section. With the increasing rates of caesarean deliveries, the incidence of CSEP is expected to rise, posing significant risks such as uterine rupture, severe hemorrhage, and infertility. Early diagnosis and effective management are critical to preventing severe maternal morbidity. In Bangladesh, where access to specialized surgical interventions is limited, non-invasive treatment approaches such as methotrexate offer a promising alternative. Objective: This study aims to evaluate the effectiveness and feasibility of methotrexate as a primary medical management strategy for CSEP in Bangladesh, assessing treatment outcomes and comparing findings with existing literature. Methods: This prospective case study was conducted from July 1, 2022, to December 31, 2024 at Gazi Medical College Hospital and Khalishpur Clinic in Bangladesh. Eleven women diagnosed with CSEP between the ages of 25 to 35 years and at a gestational age of 5 to 7 weeks were included. Diagnosis was confirmed using transvaginal ultrasonography (TVS) and serum beta-human chorionic gonadotropin (BHCG) levels. Patients were treated with a single 50 mg dose of methotrexate, with serial BHCG monitoring on 0, 3, 7, 14 and 30 days post-treatment. Additional methotrexate doses, and/or laparotomy were administered if required. TVS was performed at 7 and 30 days to confirm the resolution of the gestational sac. Results: In our study, out of 11 cases, 8 required a single dose of methotrexate, while 2 case needed two doses, and one case needed Laparotomy as the gestational sac did not resolve after 2 doses of Methotrexate. Among the eleven cases, eight (72.7%) responded successfully to a single dose of methotrexate, demonstrating a significant reduction in serum BHCG levels and complete resolution of the gestational sac within 7 days.